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Dosimetric Comparison of Image Guidance by Megavoltage Computed Tomography versus Bone Alignment for Prostate Cancer Radiotherapy

Vergleich der Dosisverteilung zwischen Lagerung nach Megavolt-Computertomographie und Lagerung nach knöchernen Strukturen bei Bestrahlung des Prostatakarzinoms

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Background and Purpose:

Daily image guidance in irradiation of prostate cancer can be based on simple portal images or on soft-tissue imaging. This study compares daily bone alignment with daily pretreatment megavoltage computed tomography (MVCT).

Patients and Methods:

Ten patients with a total of 356 fractions were analyzed. Before each fraction, the patient was positioned to match the prostate on pretreatment MVCT and planning CT. In seven fractions, rectum distension prevented a satisfactory match and the fraction was restarted after the patient went to the restroom. After treatment, organs were manually contoured on each daily MVCT and doses recalculated. Bone alignment was simulated by a software that matches the bones on MVCT and planning CT.

Results:

In the seven interrupted fractions, median improvement of rectum volume receiving full fraction dose was 14 cm3 between simulated treatment before and actual treatment after the patient went to the restroom. In the 349 noninterrupted fractions, the average difference of the isodose that covers 95% of the prostate between actual treatment position and simulated bone match position was < 1% and there was no significant change in the rectum volume with a fraction dose ≥ 2 Gy.

Conclusion:

Full fraction dose rectum irradiation can be avoided with daily MVCT by interruption of single fractions. There was no relevant benefit of daily MVCT in the noninterrupted fractions with the margins used in this study.

Hintergrund und Ziel:

Die tägliche bildgestützte Lagerung von Patienten mit Prostatakarzinom kann auf der Grundlage von „portal imaging“ oder Weichteilbildgebung erfolgen. In dieser Arbeit wird die tägliche Lagerung nach knöchernen Strukturen mit der täglichen Lagerung nach Megavolt-Computertomographie (MVCT) verglichen.

Patienten und Methodik:

Zehn Patienten mit insgesamt 356 Fraktionen wurden analysiert. Vor jeder Fraktion wurde die Prostata auf dem vor Bestrahlung erstellten MVCT in Deckung mit dem Planungs-CT gebracht. In sieben Fraktionen war dies bei vergrößertem Rektumdurchmesser nicht zufriedenstellend möglich. Diese Fraktionen wurden nach einem Toilettengang des Patienten erneut gestartet. Nach der Behandlung wurden die Organe auf jedem der täglichen MVCTs konturiert und die applizierte Dosis berechnet. Die knochenbasierte Lagerung wurde durch eine Software simuliert, die die Knochen auf MVCT und Planungs-CT in Deckung bringt.

Ergebnisse:

In den sieben unterbrochenen Fraktionen wurde durch Toilettengang und MVCT-Lagerung ein im Median 14 cm3 geringeres Rektumvolumen mit voller Fraktionsdosis bestrahlt (Tabellen 2 und 3). In den 349 nicht unterbrochenen Fraktionen war die durchschnittliche Differenz der Isodose mit 95%-Prostataabdeckung in der MVCT-Lagerung um < 1% besser (Abbildung 4), und es ergab sich kein signifikanter Unterschied für das Rektumvolumen, das der Fraktionsdosis ≥ 2 Gy ausgesetzt war (Abbildung 3a).

Schlussfolgerung:

Bestrahlung des Rektums mit der vollen Fraktionsdosis kann mit täglichem MVCT durch Unterbrechung einzelner Fraktionen vermieden werden. In nicht unterbrochenen Fraktionen ergibt sich durch die täglichen MVCTs kein relevanter Vorteil mit den hier verwendeten Sicherheitsabständen.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany

    Klaus Herfarth

  2. Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Florian Sterzing

Authors
  1. Jörn Kalz
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  2. Florian Sterzing
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  3. Kai Schubert
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  4. Gabriele Sroka-Perez
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  5. Jürgen Debus
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Correspondence to Florian Sterzing.

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Kalz, J., Sterzing, F., Schubert, K. et al. Dosimetric Comparison of Image Guidance by Megavoltage Computed Tomography versus Bone Alignment for Prostate Cancer Radiotherapy. Strahlenther Onkol 185, 241–247 (2009). https://doi.org/10.1007/s00066-009-1913-z

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